How Many ABA Hours Are Right for My Child? Understanding Medical Necessity in ABA Therapy
- Travis Gordon
- Mar 18
- 4 min read
One of the most common questions parents ask when starting Applied Behavior Analysis (ABA) therapy is: How many hours of ABA does my child need?
It’s a fair question, but the answer isn’t as simple as picking a standard program. The right number of hours should be based on medical necessity, not just a predefined schedule.
ABA therapy should not a one-size-fits-all approach. Some children require intensive intervention, while others may benefit from fewer, more targeted hours. The key is to determine what is medically appropriate for your child’s needs, ensuring therapy is meaningful, effective, and sustainable.
ABA Therapy Should Be Based on Medical Necessity, Not Program Structure
Some parents assume that ABA therapy comes in set packages—like “10-hour or 40-hour programs.” The truth is, the number of hours recommended is based on an assessment of your child’s individual needs.
A Board Certified Behavior Analyst (BCBA) conducts an initial evaluation to determine the appropriate level of support, and insurance companies require clear documentation of medical necessity before approving services.
So, what does medical necessity mean in the context of ABA therapy?
Functional Impairment and the Need for ABA
For insurance to cover ABA services, there must be clear evidence that therapy is necessary to address significant challenges related to Autism Spectrum Disorder (ASD).
Typically, the following factors are evaluated:
Presence of severe challenging behaviors – Such as aggression, self-injury, elopement (running away), or other safety concerns.
Deficits in communication and social interaction – A child’s difficulty with expressive and receptive language, understanding social cues, or engaging with peers.
Interference with daily functioning – These challenges must significantly impact the child’s ability to function at home, school, or in the community.
Developmentally inappropriate behaviors – The child’s difficulties must be more severe than typical developmental delays and must pose an obstacle to self-help, learning, and communication skills.
ABA therapy is designed to address these functional impairments and promote meaningful improvements in a child’s ability to interact, communicate, and engage in daily activities.
How Many Hours of ABA Are Typically Recommended?
While each child’s needs are unique, ABA therapy recommendations generally consider the child's age and developmental stage:
Young Children (Ages 2-5):
Recommended Hours: 10 to 20+ hours per week.
Considerations: Though younger children are generally not in school, they often have shorter attention spans and may become overwhelmed with longer sessions. Therefore, a conservative approach with shorter, more frequent sessions is often beneficial.
School-Aged Children (Ages 6-12):
Recommended Hours: 10-15+ hours per week.
Considerations: As children grow, they can often handle longer daily routines. However, it's essential to balance therapy with school and other activities to ensure a well-rounded routine.
Adolescents (Ages 13-18):
Recommended Hours: 10+ hours per week.
Considerations: Therapy for adolescents often focuses on specific skills, such as social interactions and daily living skills, requiring fewer hours than intensive early intervention.
It's important to note that while intensive programs recommending 25 to 40 hours per week exist, these are typically tailored to individual needs and may not be suitable for all children, especially very young ones. Autism Speaks
For very young children, such as 2 or 3-year-olds, full-day programs can be challenging and may resemble daycare settings rather than individualized therapy. Therefore, a conservative approach with shorter, more frequent sessions is often beneficial.
Documentation and Justification for ABA Hours
Since ABA therapy is a medical service, it requires thorough documentation to justify the number of recommended hours. Insurance companies typically require:
A formal BCBA evaluation supporting the need for ABA services.
Evidence that ABA therapy will result in functional gains beyond what would naturally occur through normal development.
Up-to-date progress notes signed by the BCBA, detailing:
The specific procedures used in therapy.
The participants (e.g., parent training, 1:1 sessions).
The setting (e.g., home, school, clinic).
The content of intervention (e.g., skill-building, behavior reduction).
The time and date of each session.
This level of detail ensures that each child is receiving the appropriate level of care based on their unique needs—not just an arbitrary number of hours.
The Growing Availability of ABA Services: What to Consider
The field of ABA is constantly evolving, and in recent years, we’ve seen a growing number of providers offering different service models, including partial & full-day programs, and the advertisement of no wait lists. This increased availability is a great step toward ensuring more children have access to therapy.
However, as a parent, it’s important to ask:
Does my child truly need this many hours? – While comprehensive ABA can be beneficial for some children, others may do better with focused, targeted interventions.
Is this program individualized or structured like a daycare? – ABA is a therapeutic intervention, not a childcare service. Ensure the program provides meaningful, data-driven progress toward your child’s goals.
Can my child handle this many hours at their age? – Therapy should be challenging but not overwhelming. If a child is showing signs of burnout or struggling to engage, the schedule may need to be adjusted.
More hours aren’t always better—what matters most is the quality and effectiveness of therapy. If you have concerns, speak with your BCBA about adjustments that align with your child’s needs.
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